This article was originally published on Psychedelic Spotlight and appears here with permission.
Psychedelic therapy is growing in popularity, but clinical trials often overlooks the unique needs of diverse racial and ethnic populations
As psychedelics increasingly permeate public consciousness, there’s a growing tendency to view these potent substances as panaceas for diverse mental health conditions. However, such enthusiasm can overlook essential questions about how diverse individuals experience them.
In particular, contemporary research on psychedelics suffers from a lack of inclusion or focus on racial and ethnic minorities. Both clinical trials and research exploring the naturalistic use of psychedelic compounds concentrates primarily on the experiences of white participants, a phenomenon that has been called psychedelic whitewashing.
In one 2018 review of 17 landmark studies from 2000 to 2017, for example, the authors found that only 4.1% of all participants were of Black or Hispanic descent, in contrast to 82.3% of participants who were white. The underrepresentation of minority populations in psychedelic research renders the generalizability of these findings profoundly limited.
Emerging studies, however, suggest that the associations between race and ethnicity, psychedelic use and mental health outcomes are significant. According to a study released in October 2022, race and ethnicity considerably moderated the associations between MDMA and psilocybin use and psychological distress and suicidality. The study sourced data from a population-based survey that included 484,732 respondents to the National Survey on Drug Use and Health–a yearly survey that collects data on mental health outcomes and naturalistic substance use patterns (substance use in natural settings) in the United States.
“This study is unique because it capitalizes on a naturalistic sample of hundreds of thousands of people, which provides really robust external validity,” says Grant Jones, one of the lead researchers of the study and a PhD candidate in Clinical Psychology at Harvard University.
“In the backdrop of psychedelic research in general in which race and ethnicity haven’t really been studied as a potential moderating factor, the study is one that demonstrates that race might indeed be impacting the associations that psychedelics share with health.”
Race, Psychedelics, and Psychological Distress
The findings of Jones’ study clearly demonstrate that different races and ethnicities experience associations between psychedelic use and psychological distress in distinct ways. For White survey participants, for example, lifetime MDMA use correlated to a reduced likelihood of psychological distress in the past month, past year suicidal ideation, or past year suicidal planning. In addition, psilocybin use among Whites conferred lowered odds of past month psychological distress and past year suicidal ideation.
For Hispanic participants, MDMA use was associated with lowered odds of past year suicidal ideation, while psilocybin use predicted lowered odds of past month psychological distress. For Asian participants, only psilocybin use predicted lowered odds of past month psychological distress. For Black, Indigenous, and Multiracial participants, MDMA and psilocybin use were not associated with lowering the odds of any outcomes. Collectively, these correlations suggest that while MDMA and psilocybin use may confer a host of protective benefits for certain ethnicities, others do not appear to glean the same benefits.
However, in addition to exploring how MDMA and psilocybin affected different races and ethnicities with respect to psychological distress and suicidal ideation, Jones and his co-researcher also investigated whether other classic psychedelics (LSD, peyote, and mescaline) might help lower the odds of psychological distress and suicidality in different ethnic populations.
“We conducted these exploratory analyses as they could reveal additional protective associations between psychedelic use and mental health outcomes for racial and ethnic minorities,” they state in the study. Their findings were revealing: Lifetime peyote use conferred significantly lowered odds of past month psychological distress for Indigenous participants. Additionally, lifetime mescaline use showed lowered odds of past year suicidal ideation for Multiracial individuals. No other psychedelic substances were associated with lowered odds of distress and suicidality for these racial and ethnic minorities.
The authors take care to emphasize that these associations are correlational. In other words, the study does not imply that MDMA or psilocybin use decrease distress and suicidality within White participants but fails to do so for Black, Indigenous, or Multiracial participants. Nonetheless, Jones and his co-author do point out a diversity of factors that may underpin these correlations and help make sense of them.
For starters, pre-drug differences and third-variable factors may contribute to these differences. For example, differences in the individual before taking the drug, such as greater openness, may influence the odds of lowering detrimental mental health outcomes. Other third-variable differences such as socioeconomic status or education may also impact associations between psychedelic use and mental health disorders.
Another factor the authors raise is the way in which diverse aspects of marginalized identity, such as gender or sexuality, may intersect to influence one’s experience of a psychedelic substance and mental health outcomes.
Race, Ethnicity, and Set and Setting
Finally, the role of set (mindset) and setting could also help explain the results of the study. As the authors point out, racism, prejudice, and discrimination are deeply entrenched features of the minority experience of the American “setting.” Furthermore, racial and ethnic minorities experience considerably more risk by engaging in illegal drug use due to racism, a factor that may detrimentally affect their mindset. Black Americans are between five and seven times more likely to be arrested for illegal substance use than are White Americans. Given the way in which discrimination may impact minority set and setting, it’s not surprising that racial and ethnic minorities may experience fewer health benefits than White user when engaging in naturalistic psychedelic use.
Jones believes the study helps to highlight the dearth of research exploring how race and ethnicity can impact the associations that psychedelics share with mental health outcomes.
“I just hope that this research can start a conversation about what the different needs are for different populations as they relate to psychedelics, and how those differing needs may need to inform how we think about developing psychedelic treatments in the future,” reflects Jones.
“This has important treatment implications down the line, as we might need to be adapting our therapies to be more culturally informed.”
Jones also believes it’s critical to diversify the field and equip psychedelic researchers of color and those of an indigenous heritage with greater resources and a platform to share their knowledge.
“I think that the field of psychedelic therapy needs to honor and recognize that many–actually most–of these substances originate from indigenous communities, and they are rich in robust practices that have existed for millennia and need to be honored,” he explains.
“There are very few psychedelic researchers of color in the space currently, so providing them with more opportunity to conduct research on their communities would be a great way to foster a wider range of set and settings that hold a broader range of populations,”